The Single Most Expensive Condition in US Hospitals
By Stephen Claypool, M.D. @WKHealth
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Sepsis continues its reign as the single most expensive condition in U.S. hospitals: $20 billion is invested into treating the 1.6 million patients diagnosed annually with the condition. Yet 258,000 lives are still lost each year—often because diagnosis came too late for effective treatment.
When it comes to sepsis, the problems are manifold. Delays in initiating treatment, inadequate treatment, inadequate cross-shift communication, challenges in diagnosing sepsis in lower-acuity areas, lack of sepsis protocols, lack of sepsis-specific quality metrics and limited financial resources all contribute to this intractable issue.
The initial presentation of sepsis can be subtle. Early detection, which requires the ability to track multiple data points and human judgment, can be greatly facilitated by system-wide change management, concurrent electronic surveillance, clinical decision support and data analytics.
Improving sepsis care requires an integrated, multi-disciplinary approach that most hospitals cannot deliver. Thus, when a Northern California community hospital was approached about participating in a pilot program that would deliver all the components necessary to impact sepsis outcomes, there was no hesitation.
Working with Wolters Kluwer Health and The Altos Group—which has been recognized by AHRQ for its efforts that successfully reduced the sepsis mortality rate at nine California hospitals by 55%—the hospital deployed a platform that blends clinical knowledge management and decision support with clinician-friendly and mobile applications that access patient information from EMRs and other IT systems. Advanced analytics are then applied to create meaningful information that is delivered to clinicians at the point of care.
Specifically, the platform brings together
- Electronic surveillance alerts to enable closer coordination of care activities and rapid delivery of comprehensive patient information to clinicians at the point of care. The alerts take into account both underlying medical conditions and medications to ensure highly specific yet sensitive alerts.
- Evidence-based treatment protocols for the septic patient that are supported by a suite of clinical decision support solutions.
- Automatic analysis of comprehensive data, including provider-level compliance with Early Goal-Directed Therapy protocols, to create the foundation for targeted and immediate response when conditions exist that have the potential to worsen a patient’s outcome.
- Change management activities such as provider education and screening tool and protocol development.
The results were immediate and significant. At the three-month mark, preliminary data showed significant improvements in key sepsis process measures, including:
- An 80% compliance rate in patient screening protocols
- A 90% rate ordering lactate tests on those patients who met criteria
- A 75% rate initiating Early Goal-Directed Therapy for those patients who met criteria
Equally impressive was the speed with which clinicians embraced the sepsis program. Hospital executives attribute the high adoption and satisfaction rates to the clinician-friendly technology and to protocols that are supported by trusted medical evidence and proven change management—and delivered with an eye toward avoiding the specter of alert fatigue that often plagues clinicians on the front lines.
Pilot testing continues. However, preliminary data indicate that an integrated multi-disciplinary approach will finally reduce the time lags and improve the delivery of care, thereby reducing sepsis mortality and shaking loose the grip sepsis holds on healthcare.
Stephen Claypool, M.D., is Vice President of Clinical Development & Informatics, Clinical Solutions, with Wolters Kluwer Health and Medical Director of its Innovation Lab. He can be reached at steve.claypool@wolterskluwer.com.